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Spontaneous rupture of an abdominal aortic aneurysm into the adjacent inferior vena cava occurs in <1% of all aneurysms and in ~3% of ruptured aortic aneurysms 1.
The features can be very atypical leading to a delay in diagnosis. The various factors that influence the clinical presentations are the origin, size, location and duration of the fistula:
- high output cardiac failure
- bilateral pedal edema (venous hypertension in the lower half of body)
- hepatic failure
- renal insufficiency (reduced renal blood flow)
- continuous bruit in the abdomen 4
Aortography is the modality of choice. Color Doppler ultrasound, CT and MRI may also demonstrate the same non-invasively. At times, the presence of a mural thrombus may obstruct the fistula.
Treatment and prognosis
Urgent surgical exploration and repair. Operative mortality of spontaneous aortocaval fistula is about 20 to 55%, figures being high predominantly due to delayed diagnosis or misdiagnosis.
- 1. Erratum. Therap Adv Gastroenterol. 2000;5 (3): 371. Therap Adv Gastroenterol (full text) - doi:10.1177/021849230000800321 - Free text at pubmed - Pubmed citation
- 2. Baker WH, Sharzer LA, Ehrenhaft JL. Aortocaval fistula as a complication of abdominal aortic aneurysms. Surgery. 1973;72 (6): 933-8. Pubmed citation
- 3. Steinke TM, Reber PU, Hakki H et-al. Haematuria and an abdominal aortic aneurysm-warning of an aortocaval fistula. Eur J Vasc Endovasc Surg. 1999;18 (6): 530-1. doi:10.1053/ejvs.1999.0940 - Pubmed citation
- 4. Dabbouseh NM, Mason PJ, Patel PJ, Rossi PJ. Endovascular repair of delayed traumatic aortocaval fistula. (2019) Journal of vascular surgery cases and innovative techniques. 5 (4): 467-471. doi:10.1016/j.jvscit.2019.06.012 - Pubmed